Potier, a shoemaker, aged 38 years, was received into La Charité on the 29th of March, 1838. He had been seized, in the October of the preceding year, with violent bleeding from the nose, which continued for three hours. This occurrence of epistaxis relieved him from attacks of giddi.

Death is generally occasioned by the heart-disease and the anomalies to which it gives rise; in four cases it was owing to rupture twice of the ness to which he had been previously subject. Towards the month of January he suddenly experienced a sensation of cold and weakness (paralysis) in the right hand, which disabled him from using his knife. This sensation disappeared in about a week. From the 27th of February he had had an occasional cough; but it was not until the 27th of March that blood was expectorated, which increased very considerably on the 28th and 29th.

The patient experienced pain in the region of the apex of the heart, and forwards and backwards at about the same elevation, which prevented him from lying on his side. The beats of the heart were frequent, but without any peculiar sound; but at the summit of the arch of the aorta, a strong bellows-sound, continued into the carotids, was heard in unison with the arterial pulse. The sound was almost equally loud at the lower angle of both scapulae, where two or three of the intercostal arteries were observed to pulsate with violence. The pulse at the wrist was 140, very large and hard, but otherwise regular. There was no sound along the femoral arteries, which beat so faintly that they could scarcely be felt. An obstruction to the current of blood in the descending thoracic aorta was diagnosed.

On the 31st there was a violent pain at the top of the ninth dorsal vertebra, between the spinal column and the scapula. The symptoms of pleuro-pneumonia increased, notwithstanding energetic treatment; and the patient died on the 9th of April.

Autopsy

The left pleural sac contained a coagulated and fluid exudation: the lung was in a state nearly approximating to pneumonia in its third stage.

The heart was large, and invested with pseudo-membranous coagula; the aorta, together with the arteries branching off from it, was dilated from its commencement to about a few lines below the origin of the left subclavian. In the middle of the free margin of one of the aortic valves, there was seated a whitish-red, and apparently old coagulum.

About five lines below the point of origin of the left subclavian, the aorta appeared to be almost entirely obliterated. The opening, which would only admit a blunt probe, was closed up with coagulated blood. It was linear in form, and surrounded by a posterior and an anterior lip, the latter of which projected far less than the other, causing the opening to approach nearer to the anterior than the posterior wall of the aorta. The tissues appeared to be normal at the contracted spot.

The Ductus arteriosus was obliterated, terminating in the concave portion of the aorta, about three-fourths of a line above its contraction.

The contraction extended over a very inconsiderable space, and was sharply defined both at its commencement and its termination. Immediately below it, the calibre of the aorta scarcely varied perceptibly from its normal dimensions. The abnormal aorta, and the iliac and femoral arteries, were also only slightly smaller than usual. The pair of intercostal arteries, branching off above the contraction, were 2'" in diameter; the remainder gradually decreased in calibre to the fourth, which appeared to be normal.

Fourteenth case, described by William Muriel in the seventh volume of "Guy's Hospital Reports" for 1842.

James Bert, a laborer, aged 25 years, of small stature, died on the 27th of July, 1842. Nine years previously, he had suffered from symptoms resembling those of an aneurism of one of the larger vessels of the chest. The symptoms gradually abated under the proper treatment, and, after a few months, he had so far recovered as to be able to work again; and was employed as a farm-servant uninterruptedly till the 20th of June, 1842. On that day, however, on lifting a heavy weight, he sprained himself. This accident gave rise to pain in the back and spasms, which were alleviated by opiates and counter-irritants applied over the spine. He lingered, however, until the 27th of July, when he died in a comatose state, which had been preceded with severe pain in the head.

On a post-mortem examination, the body was found to be somewhat emaciated, the chest deformed by the projection of the sternum, more especially towards the ensiform cartilage, and there was an inclination of the spine in the upper dorsal region towards the right side; the pericardium contained about three ounces of fluid; the heart was somewhat hypertro-phied, with some dilatation of the ascending aorta, and of the vessels branching off from the aortic arch. At the point of union of the Ductus arteriosus, the aorta was extremely contracted and almost obliterated, whilst the superior intercostal arteries, more especially on the left side, were much dilated. There was no malformation of the heart. Opposite the contracted portion there was a hard tumor, about the size of a hen's egg, which was intimately connected with the aorta and the trachea, and formed by the bronchial glands. The left sides of the bodies of the third, fourth, and fifth dorsal vertebrae were partially destroyed in the region of the tumor; the lungs and the other viscera were healthy; the head and spine were not examined.

Ascending aorta, once of the right ventricle, and once of the right auricle. Here, as is generally the case with those heart-diseases which frequently.

Fifteenth case, described by Dr. Jos. Hamernjk, of Prague (Oesterr. Wochenschrift, 1843, No. 10).

N. N. Maurer, aged 42 years, who had always enjoyed good health, had been injured eighteen years previously by the upsetting of a carriage, which occasioned contusion and a dislocation of the scapular end of the clavicle. He was seized with pains in the feet and oedema; and stated that, although these symptoms disappeared in a few days, he suffered ever since the accident from palpitation of the heart and headache, which were always removed by spontaneous epistaxis. About ten days before his death, he was attacked with pneumonia of the right side, and died on the 13th of February, 1843.

Dr. Hamernjk saw him two days before death, and found the temperature of body higher than usual, the pulse at the wrist 120, and tolerably large. The pulsations of the heart might be seen and felt between the sixth and seventh ribs, while at the same time the next two upper intercostal spaces sank inwards; the same happened with the first-named intercostal space at the diastole, whilst the two intercostal spaces above bulged out. The resonance in the region of the heart was not strikingly diminished, but the sounds of the heart, and along the greater arterial trunks, were not distinct, excepting perhaps the second sound in the pulmonary artery and the aorta, which were strong and very clear. A clear blowing sound was perceptible over the whole surface of the cardiac region, somewhat after the cystole. This sound was strongest at the left border of the sternum, from whence it diminished in clearness, although it might be heard at a considerable distance (from the dilated internal mammary artery, which was rough). There was pneumonia of nearly the whole of the right lung, of which only the upper part seemed free. A somewhat rough bellows-sound was perceptible in the carotids and the subclavians, as well as in the other large arteries. This sound was rather clear, and loud and protracted at the back, to the left of the vertebral column, at the posterior extremity of the second rib, and might be heard over the whole length of the vertebral column. Bulgings of the compressed and pulsating arteries were to be seen over the whole surface of the back, running in a twisted manner, and more especially diffused on both sides of the vertebral column in the direction of the axilla. There was no oedema.